In the early part of 2011, Bury Primary Care Trust (PCT), started to put into action plans to develop the future vision of the NHS in Bury as signalled in the Health and Social Care Bill.

A development team, consisting of a small group of key staff, was established as a catalyst to take the plans forward.

The team consisted of myself as Executive Lead GP, supported by three other local GPs (Dr. Wiz El Jouzi, Dr. Audrey Gibson and Dr. Peter Thomas), a small non-clinical team and administrative support.

During the Government's 'pause' in the natural passage of the Bill through Parliament, which allowed for more listening and engaging, our Development Team continued to steam ahead in engaging colleagues within Primary Care around our future form. We were keen to involve everyone, but paid particular attention to getting new as well as familiar faces on board and involved. One of the key drivers in facilitating the process of encouraging involvement across primary care, was the team's experienced Practice Manager who already had strong relationships that we could tap into.

The pause presented the opportunity to engage and involve even more and to get our future form right from the start. This investment has set us in good stead for the future.
Having a development team established at such an early stage has proved fruitful. This approach has given us the strong foundation we now have for the future NHS in Bury, as our CCG matures into the local leader of the NHS.

We felt it was important to be clear right from the start about our priorities to meet the needs of our local communities. These early priorities included determining the footprint for this new organisation, our structure and governance framework, and what support we would need to take us to the next level and beyond.

We engaged with our clinical peers in determining our footprint. There were a range of options on the table and the benefits and risks of each were carefully considered in conjunction with our peers. The majority, almost unanimous, vote was for one CCG for the whole of Bury, representing all 33 GP Practices. We based this decision on a range of criteria including finance, economies of scale and risk management.

Having one CCG would also be coterminous with the Local Authority and shadow Health and Wellbeing Board (HWB).
Throughout this process we have strengthened our already strong relationship with the Local Authority, particularly around the work of the HWB. The appointment of one of the development team GPs, Dr Audrey Gibson, as Chair of the HWB was a clear signal of the intrinsic links between the work of the local NHS and the Local Authority.

In relation to our organisational form, seeking the views of local practices, partners and stakeholders was vital, and their input contributed to the overall development of our CCG.

Having taken note of the existing financial recovery plans in place and being actively pursued by NHS Bury, we were keen to identify priority areas and clinical leads to focus on specific areas of service redesign and development to meet the needs of our diverse population and to support the ongoing financial recovery for NHS Bury. In particular, it was recognised that by embedding clinical pathway work more deeply in primary care and CCG working, we would be better able to ensure the financial stability for the Bury population. On this basis, initial priority areas that were identified at an early stage included COPD, urgent care services and paediatric services.

Over the summer and in advance of our shadow board being established, we initially became a sub-committee of the NHS Bury Locality Board. We then started to consult with a wide range of stakeholder groups, from GPs and their staff, to colleagues in secondary care, patients and the public in relation to the proposed shadow board structure. Involving all of our stakeholders through every step of this process has been a vital ingredient, and has assured us that our plans are all inclusive.

During the early part of this financial year, very little national guidance was available in relation to the constitution of a shadow CCG board. There was, however, more clarity when the Assignment Guidance was published, which allowed us to begin work to determine the appointment process.

All Bury GPs were invited to apply for the role of Chairman and Clinical Lead. After a robust recruitment process and assessment against a range of key competencies, with the endorsement of colleagues in primary care, I was successfully appointed to these roles from 1 September.

Recruitment and appointment to the four Clinical Lead roles soon followed (local GPs Dr Rob Queenborough, Dr Audrey Gibson and Dr Cathy Fines; and Pharmacist Howard Hughes). In relation to the three Executive roles (Chief Officer, Head of Commissioning and Head of Operations and Engagement), and Non-Executive roles, in advance of formal national guidance on recruitment, we were given permission to assign existing colleagues with the necessary and appropriate skills and attributes to these roles on an interim basis.

Assignment to the role of Director of Finance is yet to be confirmed, and it is expected that this will be a shared role across more than one CCG.

With all of the above appointments, our shadow board is becoming more established and we will soon be complete as we look to recruit a secondary care Clinical Lead role, and a 'Patient Champion' lay role. The lay champion role will have a seat on the shadow CCG board and represent the wider Patients' Cabinet.

Right from the start of our development work, engagement with all of our stakeholders has been crucial, especially patient and public involvement. We are committed to ensuring that local people have a voice in local health and social care services. We want them to be involved and help us to improve services by letting us know what they think, so we can make changes that really count. It's really important to get the right mix of people around the table and, as referenced earlier, we will also be building a Patients' Cabinet to represent the views of local people. We anticipate the Cabinet will be up and running by March 2013.

The shadow CCG Board was formally established by the NHS Bury Locality Board at its meeting in November. This is a significant step for us and demonstrates how far we have come from our humble beginnings in January 2011.

Looking ahead, the Bury CCG will assume responsibility for the leadership of the local NHS by April 2012, a full year ahead of being completely autonomous. We will take over the reins from the NHS Bury Locality Board and from next April, reporting directly into the NHS Greater Manchester Board. These steps will help to ensure that the Bury CCG is fully engaged in negotiating contracts for 2012/13 and is in a position to develop the track record, which will be required to support the authorisation process.

Our vision for the future is to be seen as the local leader of the NHS. We want to bring real added value to local health services and will continue to engage with all of our stakeholders in a meaningful way to achieve this. We want our plans to be clear and credible, and we will continually focus on delivering quality, working innovatively and productively.

Maintaining and building on our relationships with our partners and stakeholders is also key; we will be working co-operatively with colleagues in community, primary and secondary care, the Local Authority, voluntary sector, and beyond. We see taking a holistic approach to our work as essential.

The NHS, along with other public and private organisations, has and continues to go through challenging financial times on an unprecedented scale. We obviously need to do more for less, to work more efficiently while continuing to drive up the quality of local health services. It's a challenge, but one that we will relish in aspiring to achieve.